Asymptomatic full‐term infants born to women with chorioamnionitis may not need routine antibiotics

Abstract

Aim While infants with early‐onset sepsis require antibiotics, there is little evidence to support their routine use in asymptomatic infants exposed to maternal chorioamnionitis. We aimed to ascertain the incidence of culture‐proven sepsis in full‐term infants exposed to chorioamnionitis and to determine whether asymptomatic infants need routine antibiotic treatment. Methods This study was retrospective. Included were all full‐term infants admitted to our neonatal intensive care unit between 1 January 2017 and 31 May 2018 who were given intravenous antibiotics for maternal chorioamnionitis. After identifying eligible infants, relevant maternal and infant data were collected from our medical records and the Neonatal Intensive Care Units Database. Results We selected 167 term infants from 7736 deliveries. The incidence of chorioamnionitis was 21 per 1000 deliveries. The mean gestational age was 39 weeks (range 37–41), and 57% infants were male. Asymptomatic infants (76%) received intravenous antibiotics for an average of 2 days compared to 4 days in the symptomatic group (24%), p < 0.001. No infant died or developed culture‐positive sepsis. Conclusion The risk of early‐onset sepsis in well‐appearing term infants of mothers with chorioamnionitis is low. Further studies are mandatory to determine whether asymptomatic infants of mothers with clinical chorioamnionitis need antibiotic treatment.

Reducing antibiotic use in asymptomatic term infants exposed to maternal chorioamnionitis: Predictive role of sepsis risk calculator

“…In our cohort, 92% of the mothers received epidural analgesia, possibly causing fever and raising the suspicion of chorioamnionitis. Furthermore, several studies have reported that the risk of EOS in well‐appearing term chorioamnionitis‐exposed neonates is low 8,11 . Hence, treating every neonate exposed to maternal chorioamnionitis could lead to overtreatment of asymptomatic neonates 12,13 …”

“…Also, as there were no culture‐positive cases in our study, the safety of SRC for this cohort cannot be validated. Encouraged by our results and a low risk of EOS in this cohort, 8 we intend to revise the management guideline for term neonates exposed to chorioamnionitis using a quality improvement initiative and prospectively address the limitations of this study. This might improve early identification of neonates at risk of EOS based on risk categorisation, reduce unnecessary antibiotic exposure and promote mother–infant bonding.…”

“…Furthermore, several studies have reported that the risk of EOS in well-appearing term chorioamnionitisexposed neonates is low. 8,11 Hence, treating every neonate exposed to maternal chorioamnionitis could lead to overtreatment of asymptomatic neonates. 12,13 Treating well neonates with antibiotics has potential disadvantages.…”

“…Our unit followed the CDC recommendations for the management of neonates exposed to chorioamnionitis. We recently reported that the risk of EOS in asymptomatic chorioamnionitis exposed term neonates was low 8 . The aim of this study was to explore whether the SRC could guide the management of asymptomatic neonates exposed to chorioamnionitis.…”

The full blood count in screening asymptomatic infants for early‐onset sepsis: A cross‐sectional study

“…This study did not include infants that were symptomatic at the time of initial partial septic work‐up, where an FBC has been shown to be of benefit 17 . Furthermore, as all infants included in the study were receiving prophylactic antibiotics, this study does not address how an FBC result would affect the management of infants, at risk of EOS, undergoing in‐hospital observation only and not receiving prophylactic antibiotics 18 …”